Study Calls For Eliminating Isolation Techniques
By Dave Reynolds, Inclusion Daily Express
June 28, 2004
WELLINGTON, NEW ZEALAND--Seclusion, the practice of isolating individual mental health patients from everyone else, is not an effective form of treatment and puts them in danger of physical and psychological harm, a report from New Zealand's Mental Health Commission revealed Monday.
The Commission study, launched in 2001, studied the use of seclusion in mental health facilities across the country.
Researchers found that more than one-third of all mental health patients were placed in seclusion for at part of their hospitalization, at an average of 50 hours a month. At least one person was locked up for 600 hours -- the equivalent of 25 days -- in one month. The least amount of time in seclusion was one hour.
While therapy, containment and punishment were given as the reasons for isolating certain people, the study found little proof that seclusion benefited patients or staff.
"As a therapeutic intervention, seclusion was portrayed as solitude calm, serene and contemplative," the study said. "Evidence now suggests that seclusion poses significant risks to service users, including death, re-traumatisation, loss of dignity and other psychological harm. As a punishment, seclusion has been portrayed as remedial, although this rationale is not sanctioned under New Zealand law."
"The research evidence does not support seclusion as a treatment or therapy. The research literature also sees seclusion as a containment procedure that can be psychologically damaging for some people. Qualitative literature indicates that feelings of helplessness, punishment and depression are common, as are feelings of anger, frustration, confusion and fear."
The study found further that many of the actual reasons patients were secluded had less to do with the patients' behavior and more to do with their institutional environment.
"Seclusion is supposed to be a 'last resort' intervention. However, in practice the resources, staffing constraints and the operational environment limit the use of alternative practices (e.g., quiet lounges, specialling, time out, confinement without isolation or reduced sensory input). Seclusion reduces risks and ambiguity for staff and is a procedure justified by legislation and policy. Within such an environment, seclusion can become an all too easy intervention. This raises serious questions about human rights and the duty of care."
Jan Dowland, the Chair of the panel, wrote that the Mental Health Commission would like to see the use of seclusion eliminated for mental health patients, and that an immediate reduction is called for.
"Lock-up 'therapy' damaging" (New Zealand Herald)
"Seclusion in New Zealand Mental Health Service" (Mental Health Commission)